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PROFILEMONITORING OF INSECTICIDE
RESISTANCE IN INDONESIA
Winarno Sukadi (Chief of Sub Directorate of Vector Control DG DC & EH MOH Indonesia)
Hanifah Rogayah (Planner for Global Fund Malaria, DG DC & EH MOH Indonesia)
IRM Training Workshop, Hanoi Vietnam, October 5-9, 2009
• No. of Islands : 17.000• Population : 227 million• Area : 1.100 x 1500 miles sqr• No. of Province : 33• No of District : 430• Life Expectancy : 67 year
PROFILE OF INDONESIAPROFILE OF INDONESIA
Top Ten Health Problem PriorityTop Ten Health Problem Priority:1. Malaria2.Tuberculosis3. HIV AIDS4. DHF5. Filariasis
6. ARI7. Leprosies8. Immunization9. Diarrhea10.Reproductive Health
Low ModerateFree1 dot = 50 Kasus
1 dot = 250 kasusHigh
0 0‐1 1‐5 5‐49 50‐100 > 100API o/oo
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MAP ENDEMISITAS MALARIA TH. 2007
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89
10
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1 4
1 515
16
1 6
16
17
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18 19
202 0
20
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2121
21
2 2
22
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25
PE NYE BA RA N V EK TOR MA LA R IA DI INDONES IA 2008DISTRIBUTION OF MALARIA VEKTOR IN INDONESIA
Keterangan : 1. An.aconitus 6. An. flavirostris 11. An. ludlowi 16.An.sinensis 2. An.balabacensis 7. An. koliensis 12. An.maculates 17. An. .subpictus3. An.bancrofti 8. An.letifer 13. An.minimus 18 An.sundaicus 4. An.barbirostris 9. An.leucosphyrus 14.An.nigerrimus 19. An. vagus 5. An.farauti 10. An.karwari 15. An.punctulatus 20. An. umbrosus21. An.tesellatus 22. An.parangensis 23.An. kochi 24.An.ludlowi 25.An.annullaris
LOCATION OFINSECTICIDE RESISTANCE SENTINEL SITE
MTC (Bill Gat e Foundation Support):• Purworejo (Central Java Province)• South Lampung (Lampung Province)• South Halmahera (North Maluku Province)Next Round 8 GF Malaria Support:• 4 Sentinel Site propinces in Kalimantan• 6 Sentinel Site provinces in SulawesiSampling Site IRM Government Support:
1
1
2
3
4
5
6
7
89
10
11
12
13
14
1 4
1 515
16
1 6
16
17
17
18 19
202 0
20
20
21
2121
21
2 2
22
23
24
24
25
25
PE NYE BA RA N V EK TOR MA LA R IA DI INDONES IA 2008DISTRIBUTION OF MALARIA VEKTOR IN INDONESIA
Keterangan : 1. An.aconitus 6. An. flavirostris 11. An. ludlowi 16.An.sinensis 2. An.balabacensis 7. An. koliensis 12. An.maculates 17. An. .subpictus3. An.bancrofti 8. An.letifer 13. An.minimus 18 An.sundaicus 4. An.barbirostris 9. An.leucosphyrus 14.An.nigerrimus 19. An. vagus 5. An.farauti 10. An.karwari 15. An.punctulatus 20. An. umbrosus21. An.tesellatus 22. An.parangensis 23.An. kochi 24.An.ludlowi 25.An.annullaris
South Lampung
Purworejo
South Halmahera
Detection of Insecticide Resistance
• Bioassays WHO test: – 3-5 days old non-blood adult females, 25°C 80% RH– Discriminating concentration 1h exposure:
DDT 4%Malathion 5%Propoxur 0.1%Bendiocarb 0.1%
Permethrin 0.75 (pr 0.25%)Deltamethrin 0.05% Lambda cyhalothrin 0.005% Alpha cypermethrin 0.025%
• Molecular detection– Kdr gene, Ace.1R
• Biochemical tests: – AChE, esterase, G-S-transferase,
monooxygenases assays.– Fresh or frozen samples; reference strain.
– Mortality after 24h; KD50 , KD95– 98-100% Susceptible, 80-97 Suspected R, <
80% Resistance
SUSCEPTIBILITY TEST (2008-2009)IN THE 3 SENTINEL SITE
SITE SPECIES INSECTICIDE TESTED
N (mortality)( % )
STATUS
LAMPUNGS.Lampung,Rajabasa,
Waymuli
An.sundaicus Deltamethrin 0,05%Bendiocarb 0,1 %Permethrin 0,25%DDT 4%Cypermethrin0.05%Alfacypermethrin
0.005%
75 (100 %)84 (94,5 %)75 (95 % )77(27,7%77(17.95%)78(17.8%)
SusceptibleToleranceToleranceToleranceToleranceTolerance
CentralJavaPurworejo
An.barbirostris
An.maculatus
Cypermethrin 0,05%Cypermethrin 0,05%Permethrin 0.75%DDT 4 %
84 (72 %)91 (79 % )72 ( 88%)85 (87%)
ToleranceToleranceToleranceTolerance
HALSEL An.kochiAn.vagus
Permethrin 0,75%Permethrin 0,75%
52(100%)93 (100%)
SusceptibleSusceptible
No. Province Species tested Insecticide Mortality Status
1
Sulawesi Tenggara, Kab Konawe, Kec
Wawonii Barat, Desa Langara Wiwawo
An.subpictus cypermethrin 0,05% 100% Susceptible
2
Sulawesi Tenggara, Kab Konawe, Kec
Wawonii Barat, Desa Langara Wiwawo
An.subpictus Lambda cyhalotrin 0,05% 100% Susceptible
3DIY, Kab Kulonprogo,
Kec Kokap, Desa Kalirejo
An.Maculatus Bendiocarb 0,1 % 100% Susceptible
4Jatim, Kab Jember, Kec Tempur Rejo,
Kel Bande AlitAn.sundaicus Bendiocarb 0,1 % 100% Susceptible
5 NAD, Kab Banda Aceh An.subpictus Lambda cyhalotrin
0,05% 96% tolerant
STATUS RESISTENSI INSEKTISIDA DI INDONESIA TAHUN 2007INSECTICIDE RESISTANCE STATUS FOR MALARIA VECTOR
IN SAMPLING SITE IN INDONESIA 2007
No. Province Species tested Insecticide Mortality Status
1 NTT, Kupang, desa Lifuleo An. barbirostris Bendiocarb 0,1% 85-95% tolerant
2 NTT, Kupang, desa Lifuleo An. subpictus Bendiocarb 0,1% 85-90% tolerant
3Papua Barat, Kab
Manokwari,Kel Kabori
An.farauti Bendiocarb 0,1% 100% Susceptible
4
Papua Barat, Kab Manokwari, Kelurahan Pravimulya
An.punctulatus Bendiocarb 0,1% 100% Susceptible
5
Lampung,Kab Lampung
Selatan,Kec Rajabasa,Desa
Waymuli
An.sundaicus Deltamethrin0,05% 100% Susceptible
STATUS RESISTENSI INSEKTISIDA DI INDONESIA TAHUN 2008INSECTICIDE RESISTANCE STATUS FOR MALARIA VECTOR
IN SAMPLING SITE IN INDONESIA 2008
Mechanisms of insecticide resistance
IINNSSEECCTTIICCIIDDEE
1. Decreased1. Decreasedinsecticideinsecticidepenetrationpenetration
2. Increased2. Increasedinsecticide insecticide metabolismmetabolism
TARGETTARGET
3. Decreasedsensitivity of target site MonoMono--oxygenaseoxygenase
EsteraseEsteraseGlutathioneGlutathione--SS--transferasestransferasesAcetylcholinesteraseAcetylcholinesterase
GABA receptorGABA receptorSodium channelSodium channel
Behavioral resistance
Metabolic Resistance
Site insensitivity – target site
SITUATION OF RESISTANCE STATUS OF AEDES AEGYPTI WITH MALATHION 0.8 % IN INDONESIA UNTIL 2009
MATERIAL AND METHODS
• Local malaria vectors• Adult (female)• Abdominal condition ( sugar fed, unfed,
bloodfed)• Homogen (species and age) ranges ( 3 – 5
days)• Sampel base on larva reared
SAMPLE SIZE
• Each species of 75-100 adult mosquitos
• 4 replicates if it’s possible, each species per each group insecticide.
Anopheles is more likely found in :
Sunny59% Breeding Place with direct sunlight, but only 35% in lee
Breeding place is most often found in Songa Springs
Lemolemo:
Lagoon
There is springs water on river below
Lagoon formed behindSandbar
Sandbar
Breeding site salinity testing
SUSCEPTIBILITY TEST TREATMENT
AFTER IDENTIFICATION